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Evaluating the Benefits of Early Intensive Rehabilitation for Patients With Sepsis in the Medical Intensive Care Unit: A Retrospective Study 评价重症监护室脓毒症患者早期强化康复的益处:一项回顾性研究
IF 0.5 Q4 REHABILITATION Pub Date : 2021-01-13 DOI: 10.1097/JAT.0000000000000160
Bahitha Uthup, Adele Myszenski, N. Saigh, Preethy S. Samuel
Purpose: To evaluate the benefits of early rehabilitation intervention for patients with sepsis in a medical intensive care unit (MICU) and to identify the factors associated with positive outcomes at discharge. Methods: A retrospective review of 97 electronic medical records of patients with sepsis admitted to 2 similar-sized MICU pods of an urban tertiary care hospital was conducted. Bivariate analyses were conducted to compare the sociodemographics, length of stay, mobility level, and discharge disposition of 47 patients who received early rehabilitation intervention in MICU pod 1, with 46 patients who received standard rehabilitation intervention in MICU pod 2. In addition, multivariate analysis of the entire sample was conducted to identify the factors associated with positive discharge outcomes. Results: Patients in pod 1 had significantly higher level of mobility at discharge (mean difference = 0.80, P = .009) and a better discharge disposition (λ2 = 25.05, df = 7, P < .001) than those in pod 2. The positive outcomes of increased mobility and return to home at discharge were associated with rehabilitation intensity (F1,91 = 52.30; P < .001, b = 0.82) and rehabilitation initiation (adjusted odds ratio: 0.85, P = .039), respectively. Conclusion: These findings provide empirical support for the safety and benefits of providing early intensive rehabilitation for patients in the MICU with sepsis using a therapist-driven model of care.
目的:评估重症监护病房(MICU)脓毒症患者早期康复干预的益处,并确定出院时积极结果的相关因素。方法:回顾性分析某城市三级医院2个类似大小的MICU舱收治的97例败血症患者的电子病历。进行双变量分析,比较47例在MICU 1舱接受早期康复干预的患者和46例在MICU 2舱接受标准康复干预的患者的社会人口统计学、住院时间、活动水平和出院处置。此外,对整个样本进行了多变量分析,以确定与阳性出院结果相关的因素。结果:1舱患者出院时活动能力显著高于2舱患者(平均差值为0.80,P = 0.009),出院时处置能力显著优于2舱患者(λ2 = 25.05, df = 7, P < 0.001)。活动能力增强和出院回家的积极结果与康复强度相关(F1,91 = 52.30;P < 0.001, b = 0.82)和康复起始(校正优势比:0.85,P = 0.039)。结论:这些发现为采用治疗师驱动的护理模式为MICU脓毒症患者提供早期强化康复的安全性和益处提供了经验支持。
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引用次数: 2
The Utility of Mayo Clinic's Early Screen for Discharge Planning (ESDP) Tool: A Critical Narrative Review 梅奥诊所的早期筛查出院计划(ESDP)工具的效用:一个关键的叙事回顾
IF 0.5 Q4 REHABILITATION Pub Date : 2021-01-13 DOI: 10.1097/JAT.0000000000000159
Caitlyn P. Socwell, Kumutha Kanagasaba, R. Pope
Purpose: The aim of this critical narrative review was to identify and synthesize available research evidence on the utility of Mayo Clinic's Early Screen for Discharge Planning (ESDP) tool to (1) identify adult patients early during their hospital stay who require referral to specialized hospital discharge planning services (SHDCPS) and (2) review its utility in predicting patient outcomes including hospital length of stay (LOS), readmission risk, and discharge destination. This review also begins by highlighting the important role of physical therapists in discharge planning. Methods: A critical narrative review was conducted of relevant studies identified through a systematic search of PubMed, CINAHL, Embase, and ProQuest databases and subsequent systematic screening and selection process. Studies were included and critically appraised if they met eligibility criteria: studies investigating the development, predictive validity and utility of the ESDP in hospital patient populations, and studies comparing the ESDP with other discharge planning tools. Key data were then extracted and tabulated before a critical narrative synthesis of key findings was completed. Results: Seven studies met the eligibility criteria, with 5 studies receiving a rating of “good” quality. The included studies investigated the ESDP tool in adults within acute inpatient hospital settings, including heart failure, colorectal surgery, general medical and surgical, and oncology wards. Conclusion: Five of the 7 included studies were of good quality and, together, studies provided evidence that the ESDP tool correctly identifies adults requiring referral to SHDCPS. However, further research of the ESDP tool is recommended to account for variations observed in special populations and expand knowledge of its utility to predict outcomes such as hospital LOS, readmission risk, and discharge destination.
目的:本批评性叙述性综述的目的是确定和综合关于梅奥诊所出院计划早期筛查(ESDP)工具的实用性的现有研究证据,以(1)确定住院早期需要转诊到专科医院出院计划服务(SHDCPS)的成年患者,以及(2)综述其在预测患者预后方面的实用性包括住院时间(LOS)、再次入院风险和出院目的地。这篇综述也从强调物理治疗师在出院计划中的重要作用开始。方法:对通过系统检索PubMed、CINAHL、Embase和ProQuest数据库以及随后的系统筛选和选择过程确定的相关研究进行批判性叙述性综述。纳入研究并对其是否符合资格标准进行严格评估:调查ESDP在医院患者群体中的发展、预测有效性和实用性的研究,以及将ESDP与其他出院计划工具进行比较的研究。然后提取关键数据并制成表格,然后完成关键发现的批判性叙述综合。结果:7项研究符合资格标准,其中5项研究的质量评级为“良好”。纳入的研究调查了急性住院医院环境中的成人ESDP工具,包括心力衰竭、结直肠手术、普通医疗和外科以及肿瘤病房。结论:7项纳入的研究中有5项质量良好,这些研究共同提供了证据,证明ESDP工具正确识别了需要转诊至SHDCPS的成年人。然而,建议对ESDP工具进行进一步研究,以解释在特殊人群中观察到的变化,并扩大对其效用的了解,以预测结果,如医院服务水平、再入院风险和出院目的地。
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引用次数: 1
PRESIDENT'S MESSAGE 总统的消息
IF 0.5 Q4 REHABILITATION Pub Date : 2021-01-01 DOI: 10.1097/jat.0000000000000158
S. Gorman
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引用次数: 0
Missed Physical Therapy Treatments in the Acute Hospital: Toward a More Complete Understanding 急诊医院错过的物理治疗:走向更全面的认识
IF 0.5 Q4 REHABILITATION Pub Date : 2020-12-15 DOI: 10.1097/JAT.0000000000000156
G. Shan, Stephen Johnson, J. Fertitta, Jesse Kim, P. Williams, Qing Wu, Kan Ge, J. Daruwalla, Stephen D. Benning, Daniel L. Young
Introduction: Therapy sessions that do not result in treatment (nontreatment) occur in 15% to 26% of scheduled sessions. The relationship between therapist personality and nontreatment is unknown. Objective: To determine the relationship between physical therapist personality and nontreatment events in the acute hospital. Methods: The relationship between physical therapist personality (Big Five Inventory) and nontreatment was statistically modeled adjusting for other therapist and patient factors. Results: There were 522 patients and 34 physical therapists with 918 scheduled physical therapy sessions included. The average age of patients was 71 (SD = 16, range = 17-99) and 41 (SD = 7, range 27-54) for therapists. Therapists with higher openness had lower nontreatment, odds ratio 0.93; 95% confidence interval 0.87 to 0.99; P = .045. Conclusions: The positive effect of physical therapy is minimized when scheduled treatment does not occur. Lower nontreatment is associated with more trait openness. Attributes related to openness (eg, inquisitiveness and problem-solving) should be cultivated. More research is needed to understand nontreatment and guide therapists in hospital patient care.
引言:没有治疗(未治疗)的治疗会发生在15%至26%的预定疗程中。治疗师人格与非治疗之间的关系尚不清楚。目的:探讨物理治疗师个性与急性住院非治疗事件的关系。方法:对物理治疗师人格(五大量表)与未治疗之间的关系进行统计学建模,并考虑其他治疗师和患者因素。结果:共有522名患者和34名物理治疗师,包括918次预定的物理治疗。治疗师的患者平均年龄为71岁(SD=16,范围=17-99)和41岁(SD=7,范围27-54)。开放度越高的治疗师未治疗的比例越低,优势比为0.93;95%置信区间为0.87~0.99;P=.045。结论:当没有进行预定的治疗时,物理治疗的积极效果会最小化。较低的未治疗与更多的特质开放性相关。应该培养与开放性相关的特质(如好奇心和解决问题的能力)。需要更多的研究来理解非治疗方法,并指导治疗师在医院进行患者护理。
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引用次数: 1
An Explanatory Model for the Relationship Between Physical Therapists' Self-perceptions of Value and Care Prioritization Decisions in the Acute Hospital 急诊医院物理治疗师价值自我认知与护理优先决策关系的解释模型
IF 0.5 Q4 REHABILITATION Pub Date : 2020-12-15 DOI: 10.1097/JAT.0000000000000157
Joshua K. Johnson, Daniel L. Young, R. Marcus
Purpose: The aim of the study was to understand how acute care physical therapists' perceptions of the value of physical therapy inform their decisions regarding which patients to treat. Methods: This was a qualitative study using a grounded theory approach. Data were collected using semistructured interviews with a purposive sample of acute hospital physical therapists in the United States. Interview transcriptions were analyzed to derive codes and identify an explanatory model. Results: Participants included 16 physical therapists from 4 hospital systems. Their descriptions indicate that care prioritization is influenced by a self-perception of value informed by both patient- and system-driven thinking. Patient-driven thinking prioritizes factors considered most important to individual patients (eg, improved functional independence). System-driven thinking prioritizes factors most important to the health system (eg, a certain patient population or productivity expectation). The relative contribution of system- and patient-driven thinking in prioritization decisions was variable from one participant to another. Conclusions: In addition to the perceived value of physical therapy for individual patients, acute hospital physical therapists integrate organization-level factors into prioritization decisions. Future research should seek to understand how this may influence practice variation and identify practice patterns that simultaneously optimize outcomes considered important by both patients and organizations.
目的:本研究的目的是了解急性护理物理治疗师对物理治疗价值的认知如何影响他们决定治疗哪些患者。方法:采用扎根理论方法进行定性研究。数据是通过对美国急性医院物理治疗师的有目的样本进行半结构访谈收集的。对访谈录进行分析,以推导代码并确定解释模型。结果:参与者包括来自4个医院系统的16名物理治疗师。他们的描述表明,护理优先顺序受到患者和系统驱动思维的自我价值观的影响。患者驱动的思维优先考虑对个别患者最重要的因素(例如,提高功能独立性)。系统驱动思维优先考虑对卫生系统最重要的因素(例如,某个患者群体或生产力预期)。系统和患者驱动的思维在优先级决策中的相对贡献因参与者而异。结论:除了物理治疗对个体患者的感知价值外,急性医院物理治疗师还将组织层面的因素纳入优先决策中。未来的研究应寻求了解这可能如何影响实践变化,并确定同时优化患者和组织认为重要的结果的实践模式。
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引用次数: 5
Body Weight–Supported Treadmill Training in the Acute Care Setting 体重——在急性护理环境中支持跑步机训练
IF 0.5 Q4 REHABILITATION Pub Date : 2020-12-14 DOI: 10.1097/JAT.0000000000000155
Roxanne L. Bakowski (White), L. Hill, P. Goslar
Purpose: While previous studies have investigated the use of body weight–supported treadmill training (BWSTT) at various stages post-stroke, a greater focus has been on subacute and chronic stroke populations and less on how this training intervention could be implemented in the acute stages post-stroke. The purpose of our study is to demonstrate the safety and feasibility of implementing BWSTT in the very early acute phase following ischemic stroke. Methods: One-hundred and two subjects participated in BWSTT in addition to conventional therapy sessions while in the acute care hospital. Training was initiated, on average, 3.15 days from diagnosis to the initial treadmill session. Outcome measures included heart rate, blood pressure, Mobility Scale for Acute Stroke, Trunk Control Test, gait speed, and the SF-12v2. Results: Three hundred and six sessions were completed with 102 participants. Of the sessions completed, 13 were stopped due to blood pressure measurements above set parameters and did not return to within parameters during provided rest breaks. One thousand one hundred and nineteen systolic blood pressures (SBPs) were obtained during the study. Twenty-eight SBPs fell below 100, with 2 of the 28 resulting in an adverse event. Three total adverse events occurred out of 306 individual sessions, including 2 vasovagal events and an age-indeterminate peroneal tendon tear. The adverse events noted were transient and without harmful effects, and patients could complete future BWSTT sessions. Therefore, we consider 3 stopped sessions out of 306, 0.98%, as an acceptable rate of adverse events for future studies in BWSTT in patients with very early poststroke. Conclusions: BWSTT is a safe and feasible intervention to assist with higher-level physical activity in the acute stroke population during the early recovery stages.
目的:虽然先前的研究已经调查了在中风后不同阶段使用体重支持的跑步机训练(BWSTT),但更多的关注是亚急性和慢性中风人群,而较少关注如何在中风后急性阶段实施这种训练干预。我们研究的目的是证明在缺血性卒中后的早期急性期实施BWSTT的安全性和可行性。方法:102名受试者在急性护理医院除了常规治疗外,还参加了BWSTT。从诊断到最初的跑步机训练平均需要3.15天。结果测量包括心率、血压、急性卒中活动能力量表、躯干控制测试、步态速度和SF-12v2。结果:共完成了306个疗程,共有102名参与者。在完成的疗程中,有13次因血压测量值高于设定参数而停止,并且在提供的休息时间内没有恢复到参数范围内。在研究期间获得了一百一十九个收缩压(SBP)。28例SBP降至100以下,28例中有2例发生不良事件。306次治疗中共发生3次不良事件,包括2次血管迷走神经性事件和一次年龄不确定的腓肌腱撕裂。注意到的不良事件是短暂的,没有有害影响,患者可以完成未来的BWSTT治疗。因此,我们认为306次治疗中有3次停药,即0.98%,是未来对卒中后早期患者进行BWSTT研究的可接受不良事件发生率。结论:BWSTT是一种安全可行的干预措施,有助于急性脑卒中人群在早期恢复阶段进行更高水平的体育活动。
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引用次数: 1
The Role of Physical and Occupational Therapy in Pressure Injury Prevention 物理和职业治疗在压力损伤预防中的作用
IF 0.5 Q4 REHABILITATION Pub Date : 2020-12-14 DOI: 10.1097/jat.0000000000000154
Stephanie Slayton, Michelle Deppisch, Lynda Kennepp, Steve Parent-Lew, Barbara Samson, Kristen Thurman
Physical and occupational therapists are not always thought of when it comes to pressure injury prevention; however, their training and knowledge makes them key players in the interprofessional team. Pressure injuries are costly medical issues that can impact a patient's ability to rehabilitate. Therapists need to understand the causes of pressure injuries to help reduce a patient's risk. Nursing uses risk assessment instruments to identify patients who are risk for developing a pressure injury. Many of the elements that therapists address in an evaluation and daily treatment are those that are also being addressed in the risk assessment instruments. This article provides an overview to help therapists recognize ways to incorporate pressure injury prevention into their evaluation and daily practice and effectively communicate with other health care professionals.
在预防压力伤害方面,并不总是考虑物理治疗师和职业治疗师;然而,他们的训练和知识使他们成为跨专业团队中的关键人物。压力性损伤是一种代价高昂的医疗问题,可能会影响患者的康复能力。治疗师需要了解压力损伤的原因,以帮助降低患者的风险。护理使用风险评估工具来识别有压力损伤风险的患者。治疗师在评估和日常治疗中涉及的许多要素也在风险评估工具中涉及。本文提供了一个概述,以帮助治疗师认识到如何将压力损伤预防纳入他们的评估和日常实践,并与其他医疗保健专业人员进行有效沟通。
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引用次数: 0
Frailty in Acute Care: Not Just Your Grandparents' Medical Condition 急性护理中的虚弱:不仅仅是你祖父母的医疗状况
IF 0.5 Q4 REHABILITATION Pub Date : 2020-10-15 DOI: 10.1097/JAT.0000000000000152
Emelia Exum
Background and Purpose: Frailty is defined as a clinically recognizable state of increased vulnerability resulting from aging-associated declines in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. Frailty assessment is commonly reserved for the geriatric population and the outpatient setting. The purpose of this review is to discuss the concept of frailty in the acute care setting and its relevance to those in the adult, nongeriatric population.
背景和目的:虚弱是指一种临床上可识别的脆弱性增加的状态,这种状态是由于衰老导致的多个生理系统的储备和功能下降,从而包括应对日常或急性压力源的能力。脆弱性评估通常是为老年人和门诊患者保留的。这篇综述的目的是讨论急性护理环境中虚弱的概念及其与成年非老年人群的相关性。
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引用次数: 1
The Challenge of Transforming CSM 2021 转型CSM 2021的挑战
IF 0.5 Q4 REHABILITATION Pub Date : 2020-10-01 DOI: 10.1097/JAT.0000000000000151
S. Gorman
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引用次数: 0
Multidisciplinary Diagnostic Reconciliation as a Domain of Hospital Physical Therapist Practice 多学科诊断和解作为医院物理治疗师实践的领域
IF 0.5 Q4 REHABILITATION Pub Date : 2020-10-01 DOI: 10.1097/jat.0000000000000133
John Corsino
{"title":"Multidisciplinary Diagnostic Reconciliation as a Domain of Hospital Physical Therapist Practice","authors":"John Corsino","doi":"10.1097/jat.0000000000000133","DOIUrl":"https://doi.org/10.1097/jat.0000000000000133","url":null,"abstract":"","PeriodicalId":42472,"journal":{"name":"Journal of Acute Care Physical Therapy","volume":" ","pages":""},"PeriodicalIF":0.5,"publicationDate":"2020-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47207289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
期刊
Journal of Acute Care Physical Therapy
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